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Purpose due to mechanical injury caused by the hand skin and soft tissue defects in Emergency surgery is extremely common and complex injuries, repair and diverse. Treatment effect greater impact on the form and function of the patients hand, a direct impact on their lives and work. In order to alleviate the suffering of patients, to maximize the recovery of the form and function of the hand, to improve the quality of life of patients, to relieve the family and social burden, our study of the principles and techniques of the flap of skin and soft tissue defects of hand. PATIENTS AND METHODS cases: first fifty-three Central Hospital of PLA (PLA orthopedic trauma center) hands surgical ward. : 2005 2009 1. The number of cases: hand skin and soft tissue defects 798 cases of hospitalized patients; males and 432 cases, 366 cases of women. Age 17-52 years, mean 32-year-old. Injury reasons: machine crush injury in 306 cases, a chainsaw injury 254 cases, hot crush 84 cases, the lathe and injury 113 cases, traffic injuries in 41 cases. Injury type: single skin and soft tissue defects 354 cases, one-handed 2-4 skin and soft tissue defects 278 cases, 113 cases off finger with skin defects, with one hand above skin defects in 53 cases. Injured to treatment time: 8h 614 cases, 8h-12h158 cases, 26 cases in 12h after. Repair methods include: random flap in 524 cases (259 cases of abdominal flap, o refers to the flap 215 cases, subcutaneous pedicle VY advancement flap 27 cases, 23 cases of subclavian flap); the pedicle flap 211 cases (dorsal nerve Nutrition flap 48 cases, 69 cases of arterial flap back flap 38 cases, bone index finger back flap 23 cases, 21 cases of metacarpal dorsal flap pedicled ulnar artery the wrist leather flap 12 cases); vascular anastomosis free medial leg perforating branch skin flap in 63 cases (the free hallux series of flaps 16 cases, free anterolateral thigh flap in nine cases, six cases of ulnar artery free skin flap, free hallux A flap five cases the flap two cases, free venous flaps 25 cases). Results There were 798 cases. 797 flaps all survived, free venous flap necrosis due to infection of vascular thrombosis. One cases free miniature ulnar artery skin flap after 2 days artery crisis, improved after re-anastomosis artery by surgical exploration and survived. Two cases of dorsal metacarpal artery reversed island flap one day after silt purple and tension blisters, removal of the tension sutures after the pedicle improved recovery. 461 cases were followed up in 798 patients, 337 cases were lost to follow. By: follow-up to the hospital referral 157 cases, telephone follow-up of 136 cases, 115 cases of petition and home visits to 53 cases. 6 months follow-up time: discharged -1 247 cases, 126 cases in 1 year to 2 years, 64 cases of 2 years to 3 years 3 years 4 years 24 cases. The mean follow-up time of 28 months. The follow-up results: 24 cases of abdominal flap bloated hinder neighbor means holding objects, three months later the hospital to give flap fat plastic surgery. 426 patients flap shape, color, texture, flap pain, temperature sensation, tactile good recovery, two-point discrimination 6-10mm. Holding objects without abnormal sensation and fine finger function recovery. 11 cases of finger sensory recovery poor, could easily lead to frostbite, burns, and wear. Hand function recovery function assessed by upper extremity part of the Chinese Medical Association Society of Hand Surgery Trial criteria adopted, excellent rate of 92%. The donor site wounds were Ⅰ healing, no hypertrophic scar formation, function unaffected. Conclusion: The choice of flap principle generally should follow the \far. recovery principles into account by the District for the area's appearance and function. 2, the the Creative assembly-line type operation similar organizations synchronization repair that structure to structure repair: the anatomical level, easy-to-digest, Volume carpet be debridement \order circling vascular anastomosis free flap graft vascular anastomosis using any designated line stitches, then order circling suture few needles, each needle to stay suture next needle traction lines, does not require a fixed number of suture needle , not Louxue standard suture 4-5 pin can generally This method reduces the seam and the probability of sidewalls, reduce the incidence of vascular crisis and improve the speed and quality of the double operation Vascularized also single person to operate the vascular anastomosis provide a new method. 4 Creative the \protection of the the wound small blood vessels, and nerve branches can retain between ecological organization, but also to achieve the purpose of thorough debridement.
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